LaraT23

We don't reband unless the patient is on a new visit or if the band is damaged or unreadable. It has worked well for us, all redraws must have the band number on them so that we can make sure it matches the original.

I supervise a transfusion service in a 125 bed hospital, did not go through a formal school and passed with flying colors. I did have to get some more observation time at my supplier donor center. As for research project, there are tons. If you want to do something technical, molecular is the up and coming thing. There are differences in the results of this testing over traditional serology. If not technical, blood utilization, validation processes, Quality management... You will do fine, I am sure!

No We just use the 72 hour rule on everyone unless the units are short dated, then we will release them if it seems some one will use them.

We do QC our panels. We do a mixture of c and D antisera and also saline on arrival and before we put it in use. Then we run the pos ( D and c ) 72 hours before it expires to confirm all cells still react at the same strength.

We implemented 6.0 last July. Compatibilites are based on product and type. You have to configure your blood type dictionary and in the middle box on page 2 you can differentiate by product. I will to try to attach a screen shot. You can also on the first page of the specific blood type dictionary entry say whether or not you can emergency release products of that type. BLOODTYPE.doc

I was wondering if anyone else is seeing an issue with screen cells 1&2 being about 1+ pos with screen cells lot# VSS400 or gel card lot#041111001-21? I have three in the last four days. The extended antigen sheet is negative on those cells. We always do full crossmatches in these cases, but just finding things inconclusive. We redrew the patients and opened new bottles of screen cells. I don't have new lot until next week, so maybe then we will find some answers. Also, I had a bad bottle of ABO dil 2 plus, which was giving us random pos RH control wells in the gel, changed the bottle and it was fine. Anyone else found this issue?

I was pointed in John Mould's direction by Marilyn Moulds whom I had met at a couple of conferences. I had a strange and puzzling patient sample and was stumped. John offered to work it up and gave me an official report and wonderful advice. He did all of this free of charge for the sake of the search. I regret that I was not able to meet him in person. What a wonderful fount of knowledge is lost. My condolences to his family.

I had this happen here last year. This time it was an older male being treated for myelodysplastic syndrome secondary to an unknown. His bone marrow was really suppressed and he got a lot of upper resp. infections. He came in about a week post outpatient transfusion, with olive green to black serum, horrible jaundice and a hgb of 5.5. Of course the blood banker on duty thinks, delayed HTR. But found nothing in the panel. He reacted but very nonspecfic and had strong DAT. So, we did a little digging and found that he reacted much more strongly in the gel than in the tube. Come to find out that there is antibiotic included in the gel as a preservative. I called the doc and talked with her about all of our findings and she took him off his current course of antibiotics and switched him to non cephalosporins. Low and behold he perked up, stopped hemolyzing and had normal colored serum about a week later. Very important to keep the role of antibiotics and other meds in mind when investigating these cases.

We use the KB stain route when the RH of the baby cannot be determined. It is a protocol in our Women's services area that all abdominal trauma get the KB stain. As far as miscarriages, one vial of RH immune globulin is give is the mom is 20 weeks or less, anymore than that and we give the vial and do the KB stain just to make sure we don't need more. As far as the rosette, we only do that one if the RH of mom and baby are known.

I second the suggestion to keep the cards. I have them all kept back, and the weekend techs parafilm them so that they aren't cracked when I see them on Monday. It has lead to quite a few revalations, and one firing. But does answer a lot of questions like these.

We do charge for both. All Xm have an immediate spin charge, for those with gel XM we had another test in the requisition that is a charge only for the gel testing.

We had a few issues with this recently, as I was using just a 20 minute time limit, which made no sense to nurses. so, we have recently begun placing hemotemp stickers on every unit that leaves the blood bank. This was we have a documented temp if they want to return it. I do still tell them that they get about 17-20 minutes before we are getting in the dangerous temp range. Cooler issued red cells also get stickers and for any that need to be in OR greater than the validated time of 4 hours, we switch out the ice pack. They get stickers too.

I did forget to mention that if your patient is experiencing a reaction that is extravascular in nature, the DAT may never be positive. For instance, RH antibodies do not fix complement, and those cells involved are removed by the RES quite quickly and destroyed extra vascularly. This would result in the DAT not becoming positive because: 1. Those cells are removed, and 2. The hemolysis is occuring outside of the circulation.

We had a patient with very similiar results not too long ago. Ours came in to ED with blackish green plasma two days post outpatient transfusion, PANIC ensued. After all was said and done, our patient was having a hemolytic episode due to a combination of immune response to antibotics and his chronic myelodysplastic syndrome. He also had an Anti-K ( historical) had received K neg units and his DAT was not positive for several days. It was only microscopically pos at that. So, after checking his peripheral smear ( major schistocytes and spherocytes) we noticed that his was reacting non specifically to the gel, which has antibiotics added to it, we washed his cells X4 and used tube method only and found all the non specific stuff gone. The patient was taken off the antibiotics and we have had no other issues.

The nurses are balking at 20 minutes because I am writing them up for violating the Blood bank policy but the nursing policy states 30 minutes. So, we are not in consensus about that time. I am planning to do a study with some expired units my blood center is sending me. Will let you all.

What time limit is everyone using that a unit must be started after it is issued? Nursing service is balking at our 20 minute limit, which we have had as a policy for 10 years. Our new manager for a couple of the floors says everywhere she has worked for her entire career used 30 minutes. What is the consensus here?

We actually just went with a barcoded band with an area for a pre-printed label. I ask that two persons sign the label before it is applied to the patient's band with the date and time to verify that the preprinted label matches the hospital ID band. Our staff really likes them much better than the old hand written ones. Less risk of typos or unreadable handwriting.

We use a 20 minute time limit for returns, and also take the temp at return with a thermometer with a probe attached. For anything issued in a cooler that is potentially going to be out for along time, we use Hemotemp II temp stickers that indicate if the unit has ever gotten out of temp.

We just go with the physician order. I had an order from a cardiologist just the other day for a split washed unit. The internist ordered just regular banked units the next day. So much for physician communication right?

We do essentially the same thing. Incubation at 4 degrees for 10 minutes and the room temp incubation for 10 also, just before so that we can see at what temps we are getting the strongest reaction.

My two cents: We had a patient very similiar to this, and he eventually developed a positive DAT. We use Ortho reagents, and the poly AHG will detect all IgG subclass coating. I sent my specimen to my reference lab, who uses Immucor reagents, and they got a negative DAT. He was off and on incompatible with random units. I ended up sending most of what I had left to John Moulds at Lifeshare. He has some for research use only reagents of his own and after an investigation found the cells to be heavily coated with not onlyI gG4 but also IgA ( also not detected in Immucor reagents). So, perhaps that sheds a little light on things? My particular patient was A pos and R2R2, if he had not passed away I would have then tried to pick up some anti-f perhaps just with adsorption on rr cells.

In any Blood Bank there is the possibility, though no one likes to admit it, that we can mis-label or mis-pipette. An immediate spin XM does not guarantee this will not happen and in my opinion does not make the whole process any safer. I have done a small study in house and the gel picked up ABO incompatibility 100% of the time with 15 patients sampled. I just like to think about what it is we are hoping to accomplish for each thing we do.

Good ness NO! why the pathologist would have to sit in the blood bank some days. The only thing at all close that we need path approval on is if we have to tranfuse an RH neg elderly person with RH pos in a crisis.

I tend to worry more about the amounts of plasma in the unit, of course we use exclusively apheresis platelets here. None the less transfusion of incompatible plasma would be my main concern, so in that case, I would go with AB as a next choice and stay away from A and O unless you can somehow wash those platelets. This is just as the child is small.

True, you can add a comment on that specimen and put that this was a new draw or that a CBC tube and the spec number was used to confirm. I don't usually do different draws on patients, even with no history. I have a second identifier on the bbk band ( two person signature) on all patients. The CAP standard says that two draws is one way to satisfy that, but not the only one. We cite the standard that talks about minimizing blood draws and the fact that you can't always get to the patient to re-draw, so we didn't think we would be consistently doing the same thing all the time. It is up to your institution of course, but there is no way around the add on XM going on the most recent spec number.